Discordance of Estrogen Receptor,Progesterone Receptor,Cerb-B2,Ki-67 Index and P53 Expressions between Primary and Recurrent or Metastatic Sites in Breast Cancer Patients / 中国医学科学院学报

Objective To approach the discordance of estrogen receptor(ER),progesterone receptor(PR),Cerb-B2,Ki-67 index and P53 expressions between primary and regional or distant recurrent lesions in recurrent or metastatic breast cancer patients.Methods Clinical and pathological data of 56 recurrent or metastatic breast cancer patients who were treated in Peking Union Medical College Hospital from January 2001 to February 2015 were retrospectively analyzed.The changes in the expressions of ER,PR,Cerb-B2,Ki-67 index,and P53 status were analyzed.Results The hormone receptor positive rate between primary tumor and recurrent or metastatic sites decreased from 60.7% to 57.1% for ER and from 55.4% to 44.6% for PR,respectively.Changes in hormone receptor status were seen at the rate of 12.5%(7/56)and 16.1%(9/56)for ER and PR,respectively.Cerb-B2 receptor positive rate increased from 19.1% to 29.5% and the discordance rate was 9.1%(4/44).The discordance rate of Ki-67 index was 24.5%(12/49).The P53 receptor positive rate increased from 37.5% to 55.6% and the discordance rate was 13.3%(6/45).Conclusion Although the relevant rules of above changes are still controversial,these findings still have great clinical significance for making effective treatment decisions of recurrent or metastatic breast cancer.

One case of unilateral breast cancer treated with contralateral prophylactic mastectomy simultaneously and confirmed pathologically as synchronous bilateral primary breast carcinoma / 中华内分泌外科杂志

We report one case of unilateral breast cancer treated with contralateral prophylactic mastectomy simultaneously and confirmed pathologically as synchronous bilateral primary breast carcinoma.The clinical characterization and diagnosis of bilateral primary breast cancer combined with a review of literature were discussed to serve as a reference for early diagnosis and treatment of the disease.

Scrutiny of extent of axillary node dissection for patients with primary breast cancer

Background: Carcinoma of the breast is the most common of non-skin malignancies in women and is second to lung cancer is a cause of cancer deaths. A woman who lives to age 90 has a one in eight chance of developing breast cancer. It is as ironic and tragic that a neoplasm arising in an exposed organ, readily accessible to self-examination and clinical surveillance, continues to exact such a heavy toll. The aim of the study: To determine, if differences in the extent of axillary node dissection would alter the number of reported positive nodes, to emphasize the presence and importance of dissecting the inter pectoral node (Rotter’s Node) in Modified Radical Mastectomy. Materials and methods: This study was conducted in the Department of General Surgery, Government Stanley Medical College, Chennai in 2018. Patients were evaluated according to NCCN guidelines and were subjected to Modified Radical Mastectomy for whomsoever it was needed. 32 cases underwent Modified Radical Mastectomy with complete axillary dissection (level I/II/III and inter pectoral node) according to the identical procedure. The dissection was carried out in all patients, irrespective of whether they had palpable nodes or not clinically. Results: An average of 13 lymph nodes was examined per case (range: 8−20). Axillary lymph node involvement was found in 56% of the cases (18/32). Of the 18 cases, 83% (n = 15) had involvement of level I/II nodes only, and 16% (n = 3) had positive ALN in levels III and, or, inter pectoral nodes, in addition to the level I/II. Involvement of lymph nodes in level III and inter pectoral nodes without a level I metastasis was not found. By the inclusion of level III to a level I/II dissection, two cases (11%) was converted from one to three positive nodes (pN1) to ≥4 positive nodes (pN2). Involvement Rosy Adhaline Selvi, Manimegalai. Scrutiny of extent of axillary node dissection for patients with primary breast cancer. IAIM, 2019; 6(3): 212-216. Page 213 of lymph nodes in level III was found in 3 cases (16%) 10/32 cases (31%) had ≥4 positive nodes who required adjuvant therapy. Conclusion: Variations in the level of axillary node dissection for breast cancer which includes the inter pectoral and level III nodes can result in significant changes in the number of positive axillary nodes stepping up the pathologic nodal status from pN1 to pN2. This can potentially bias adjuvant therapy recommendations if treatment decisions are based on this prognostic factor.

Clinical features and prognosis of 28 patients with ipsilateral double concurrent primary breast cancer / 肿瘤

Objective: To investigate the clinicopathological features and prognosis of patients with ipsilateral double concurrent primary breast cancer. Methods: The clinical records and follow-up information of 28 patients with ipsilateral double concurrent primary breast cancer between January 2006 and January 2008 were reviewed retrospectively. Results: The two tumor lesions were detected by MRI with a high sensitivity of 90%. The coincidence rate of pathological type of the two tumor lesions was 64%. The two tumor lesions were both detected by immunochemistry in 10 cases, and the results showed that the expression status of estrogen receptor (ER) and progesterone receptor (PR) was consistent, but the expression status of Ki-67 and human epidermal growth factor receptor 2 (HER2) was inconsistent. The coincidence rate of molecular pathology of the two tumor lesions was 70%. Univariate prognostic analysis showed that the overall survival time of the patients with ipsilateral double concurrent primary breast cancer was significantly associated with tumor stage (P = 0.004) and ER status (P = 0.000). Tumor stage (P = 0.003), axillary lymph node status (P = 0.032) and ER status (P = 0.022) affected the disease-free survival time of the patients with ipsilateral double concurrent primary breast cancer. Multivariate prognostic analysis showed that tumor stage was an independent prognostic factor of ipsilateral double concurrent primary breast cancer. Conclusion: The coincidence rate of pathological type of two tumor lesions in ipsilateral double concurrent primary breast cancer is higher, and the tumor stage is an independent prognostic factor.

Evaluation of synchronous bilateral primary breast cancer by MRI and pathology / 实用放射学杂志

Objective To analyze the magnetic resonance imaging (MRI)and histologic features of the synchronous bilateral primary breast cancer (sBPBC).Methods MRI findings and pathologic types of sBPBC in 20 patients in our institute were reviewed retrospectively. The MRI features of sBPBC were compared with the pathologic types,respectively.Results 20 sBPBC patients with 41 lesions were found with the most common pathological type of invasive ductal carcinoma in 26 (26/41 ).Bilateral lesions had the same pathological types in 1 1 patients(1 1/20),and different types in 9(9/20).The MRI features of invasive breast cancer were more characteristic than that of early breast cancer.In 20 patients,the first and second primary breast cancers with similar MRI findings were found in 6(6/20).In 10 patients with sBPBC,the first cancer was advanced breast cancer,and the second was early or low grade breast cancer.Conclusion (1)The most common pathological type of sBPBC is invasive ductal carcinoma,and the pathological types of bilateral lesions are not similar. (2)The MRI features of the first and the second lesions in bilateral primary breast cancer showed lower similarity,and the bilateral lesions should be diagnosed independently.(3)In patients with sBPBC,some cancers are advanced breast cancers,and the second ones are early cancers,suggesting the lesion should be followed up if the contralateral one is diagnosed as breast cancer.

Ki-67 expression in T1 primary breast cancer tissue and its relationship with Her-2 and ER / 国际外科学杂志

Objective To study the expression of Ki-67 in T1 primary breast cancer tissue and its relationship with Her-2 and ER,evaluate the prognosis of early breast cancer.Method s Sixty cases of women T1 primary breast cancer tissues of 60 female cases from January 2008 to June 2011 were selected.The expressions of Ki-67 were detected by immunohistochemieal method and the relationships between Ki-67 and clinical-pathological fcatures,Her-2 and ER were analysed.Results The expression of Ki-67 in T1 primary breast cancer was 55% among the 60 patients.The expression of Ki-67 was not related with the clinical-pathological type of breast cancer and menopause (P＞0.05).The expression of Ki-67 in group with lymph node metastasis was higer than in group without lymph node metastasis(P =0.047 ,P ＜0.05).The expression of Ki-67 in Her-2positive group was higher than Her-2 negative group (P= 0.021,P＜0.05),and the expression of Ki-67 in ER positive group was lower than that of ER negative group (P = 0.037,P ＜ 0.05).Conclusions The expression of Ki-67 in T1 primary breast cancer indicates the possibility of lymph node metastasis,and its positive correlation with Her-2 positive expression,ER negative expression indicates poor prognosis.

The Correlation of Serum HER-2/neu and CA15-3 in Patients with Metastatic Breast Cancer / 한국유방암학회지

PURPOSE: The extracellular domain (ECD) of the HER-2/neu oncoprotein, whose molecular weight is the range from the 95 kD to 105 kD, is shed into the blood from the cell surface via, proteolysis by a metalloprotease. A monoclonal antibody immunoassay has been developed for measuring the circulating concentrations of serum HER-2/neu ECD (following serum HER-2/neu). Serum HER-2/neu has been reported to be correlated with an increased tumor volume in those patients suffering with breast cancer. We measured the serum CA15-3 level, which is a surrogate marker of the tumor burden, we analyzed the correlation of the serum CA15-3 with the serum HER-2/neu and we analyzed the association of both markers with the clinical outcomes. METHODS: The sera for the analysis of both HER-2/neu and CA15-3 were obtained from 99 healthy Korean women, 66 primary breast cancer patients and 43 metastatic breast caner patients. The serum HER-2/neu level was measured quantitatively with using an ADVIA Centaur(R) automated immunoassay analyzer (Bayer Health Care LLC, Diagnostics Division, Tarrytown, New York, USA) and the CA 15-3 level was measured via radioimmunoassay. RESULTS: The serum HER-2/neu level was increased 23 metastatic cancer patients (53%). On the analysis of the correlation of serum HER-2/neu and CA15-3, the correlation coefficient (r) was 0.8072. Thus a positive serum HER-2/neu test in breast cancer patients was highly associated with the CA15-3 level for assessing whether metastasis was present or not. For the relationship between primary breast cancer and metastatic breast cancer, the former was classified as the control group and the latter as the patient group. The results of the Receiver Operation Characteristic (ROC) curve for serum HER-2/neu and CA15-3 showed no statistically significant differences (p=0.176) but the diagnostic efficacy of the serum HER-2/neu test was measured more exactly than that of CA15-3 and CA15-3 a tool for measuring a tumor marker for the diagnosis of whether metastasis was present or not. CONCLUSION: Serum HER-2/neu is a significant independent predictive prognostic factor for metastatic breast cancer patients. In view of the results we have achieved so far the serum HER-2/neu level in metastatic breast cancer patients may play an important roll as an independent tumor marker.

Clinical Significance of HER2/neu Gene Quantification and MAGE assay in Primary Breast Cancer / 대한진단검사의학회지

BACKGROUND: Many studies have reported that the HER2/neu gene and melanoma antigen gene (MAGE) are correlated with the progression and the prognosis of primary breast cancer (PBC). Since anti-HER2/neu monoclonal antibodies were introduced for an adjuvant treatment for PBC, the needs for the assessment of the HER2/neu status have been increased. Accordingly, we compared two methods evaluating HER2/neu status, and performed MAGE assay simultaneously. In addition, we also investigated the association of HER2/neu and MAGE with known disease parameters, and their clinical significance in PBC patients. METHODS: In 50 patients with PBC, HER2/neu protein and HER2/neu gene expression were assessed by immunohistochemical stain (IHC) and real-time quantitative polymerase chain reaction (Rt- Q-PCR), while MAGE expression was assessed by reverse transcriptase (RT)-nested PCR. RESULTS: The HER2/neu protein overexpression and overamplification were noted in 68.0% (34/50) and in 68.1% (32/47) of the patients, respectively. The concordance rate between these two methods was 61.7% (29/47) and the kappa value by analysis of reproducibility was as low as 0.086. HER2/neu protein overexpression was significantly correlated with P53 expression. HER2/neu overamplification was significantly correlated with histologic grades and inversely correlated with estrogen receptor (ER) expression (P=0.033). MAGE was expressed in 46.9% (23/49) in the current study. MAGE expression was shown to be significantly correlated with HER2/neu gene amplification (P=0.002), histological grades and P53 expression, and inversely correlated with ER expression (P=0.014). CONCLUSIONS: The current study revealed that the concordance between IHC and Rt-Q-PCR for HER2/neu evaluation was low in PBC. MAGE expression was significantly correlated with HER2/neu gene amplification and also associated with some clinical prognostic factors. So it is considered that MAGE expression has more important clinical prognostic significance than HER2/neu expression.

Clinical Usefulness of Circulating Hepatocyte Growth Factor (HGF) in Breast Cancer / 대한진단검사의학회지

BACKGROUND: The hepatocyte growth factor (HGF) is a cytokine modulating epithelial cell proliferation and motility. A circulating HGF level is frequently increased in a variety of tumors including advanced breast cancer. The clinical usefulness of measuring circulating HGF in breast cancerwas evaluated in this study. MATERIALS AND METHODS: The plasma HGF levels in patients with primary (n=58) and recurrent breast cancer (n=13) were measured by the ELISA method using Quantikine (R&D, Minneapolis, MN, USA) kit. The results were compared with those of age-matched healthy controls (n=53). The mean (+/-SD) levels of HGF were also compared between primary and recurrent breast cancerpatients. The correlation of the circulating HGF level and the conventional prognostic factors such as tumor size, lymph node involvement, Her-2/neu over-expression, DNA aneuploidy was studied to evaluate the clinical usefulness of HGF as a new prognostic indicator in breast cancer. RESULTS: Plasma HGF levels (mean+/-SD) increased in breast cancer patients (788+/-853 pg/mL), compared with those of age-matched healthy control women (426+/-120 pg/mL) (P<0.05). Patients with recurrent breast cancer (1, 945+/-1, 544 pg/mL) showed increased HGF levels compared with primary breast cancer (592+/-132 pg/mL) (P<0.001). No significant correlations between plasmaHGF levels and conventional prognostic indicators of breast cancer including tumor size, lymphnode involvement, Her-2/neu over-expression, DNA aneuploidy, and histologic grade were found. CONCLUSIONS: The above findings suggest that the measurement of plasma HGF levels in breast cancer patients may be useful for early detection of recurrence.

Clinical analysis of primary bilateral breast cancer / 医学研究生学报

Objective:To explore the clinical diagnosis,therapy and pathologic characteristics of primary bilateral breast cancer in order to improve the survival of breast cancer patients.Methods:Eleven cases of primary bilateral breast cancer patients were retrospective analysised.Results:Among the 11 cases of primary bilateral breast cancer patients,2 cases were dead for multi organ metastasis;9 cases survived.Among which one has been alive for 6 years after operation.Conclusion:The early diagnosis and treatment of the second primary cancer remain the key factor to improve the outcome of the bilateral breast cancer patients.

The role of ~(99)Tc~m-Sandostatin somatostatin receptor imaging in the evaluation of primary breast cancer / 医学研究生学报

1.20 was defined as posi-tive imaging.Results:Out of46 patients,40 were malignant tumors;6 had benign lesions.The sensitivi-ty,specificity and accuracy of99Tcm-Sandostatin in the detection of breastcancer were 87.5%,83.33%,86.96%,respectively.99Tcm-Sandostatin imaging was false negative in 5 patients with breast cancers.In6 patients with benign lesions,5 patients was true negative,but one patient with chronic breast abscess.T/N ratio was 2.370?0.933,1.295?0.648 in breast cancer and benign lesion respectively.The T/Nratio was higher in breast cancer than benign lesion(P

Expression of p53, c-erbB-2 and cathepsin D in relation to hormone receptors in primary breast cancer.

The immunohistochemical expression of p53, c-erbB-2, and cathepsin D oncogene proteins was examined in 494 primary breast carcinomas. This study aimed to investigate an association of expression of these three proteins with other variables known to be related to poor prognosis as well as with 5-year disease free survival (DFS). P53, c-erbB-2, and cathepsin D alone or in combination was negatively correlated with the presence of estrogen and progesterone receptors in breast cancer tissues. Alteration of these oncogenes rendering an expression of the proteins may affect the synthesis of steroid receptor proteins during the course of breast cancers. However, their significance as predictors of 5- year DFS was not achieved in this group of patients. Lymph node invasion was the only independent indicator for recurrent or metastatic breast carcinoma.

Preliminary study of clinical value of serum prolactin in association with CEA, CA15-3, MCA and c-erbB-2 in primary breast cancer.

The clinical value of circulating prolactin as a marker for the diagnosis of primary breast cancer compared with other serum markers was evaluated in Thai women. Forty women with primary breast cancer, 20 women with benign breast disease and 20 normal women were included in the study. Single serum levels of prolactin, CEA, CA 15-3, MCA and c-erbB-2 were simultaneously measured. At 95% specificity, prolactin gave the highest diagnostic sensitivity (92.5%) compared with a sensitivity of 10-30% obtained from the other markers studied but did not correlate with any of them. Concentrations of CEA, CA 15-3, MCA and c-erbB-2 in 40 breast cancer tissue were related to each other by multiple regression analysis and they also showed good positive and negative agreement among subjects. Thus, measurement of a single marker among four of them should be economically and clinically appropriate. CEA when compared with other markers, showed a better relationship with clinicopathological parameters e.g. tumor diameter and axillary lymph node involvement. This preliminary study suggests that prolactin and CEA may be a good combination of paired serum markers for the early detection of breast cancer. A prospective study should be performed in order to demonstrate the exact relationship of elevated blood prolactin levels and the risk of breast cancer in the Thai population.

Serum and tissue markers in primary breast cancer.

Thirty-three primary breast cancers were analyzed for prognostic markers, Immunohistochemical assay of c-erbB-2 oncoprotein was performed in formalin fixed paraffin-embedded tissue. Enzyme immunoassay and radioreceptor assay for ER and PR were respectively done in tumor cytosol. Pre-opertive blood sample obtained from this group of patients were analyzed for CEA, CA15-3 and MCA levels. About 54% of tumor had c-erbB-2 positive staining. Direct association was observed between tumor size, pathological stage, serum CEA levels and c-erbB-2 expression. No significant association existed between the expression of c-erbB-2 and lymph node invasion, histological type, ER and PR status, serum CA15-3 or MCA levels. Increased incidence of c-erbB-2 overexpression among breast cancer patients with large tumor, more advanced stage and elevated CEA level suggests its value for indicating of greater tumor aggressiveness.

Overexpression of c-erbB2 and its Relationship with Chemotherapy in Breast Ccancer / 한국유방암학회지

Purpose c-erbB2 encodes 185 kDa oncoprotein tyrosine kinase activity and has homology to the epidermal growth factor. c-erbB2 proto-oncogene is found to be overexpressed in approximately 20 to 30 % of primary breast cancer and has been associated with poor prognosis and lower response to conventional chemotherapy. Materials and methods We performed a stedy on 40 infiltrating ductal breast cancer treated with primary surgery and adjuvant chemotherapy. We investigated c-erbB2 expression by immunohistochemistry in paraffin-embedded tissue using polyclonal antipeptide antibody (DAKO). We evaluated the relationships between its expression and the results after over 6 cycles of adjuvant chemotherapy including cyclophosphamide, methotrexate and 5-FU. Results The median age at diagnosis was 43 years and the median follow-up time was 47.3 months. Thirteen (32.1%) of 40 patients showed the c-erbB2 overexpression in the external domains of protein. There were no correlations among c-erbB2 amplification and other prognostic factors such as hormonal receptors, histologic grade and tumor size. Estrogen receptor and progesterone receptor showed tendency of inverse correlation with c-erbB2 overexpression but it was not statistically significant (p>0.05). c-erbB2 positive patients showed shorter disease free survival compared to c-erbB2 negative patients in univariate analysis (p0.05). Conclusion These findings suggest that overexpression of c-erbB2 may be a marker of poor response to adjuvant chemotherapy with CMF regimen and may be an indicator of more aggressive therapy.

Overexpression of c-erbB2 and Its Relationship with Chemotherapy in Breast Cancer / 대한암학회지

PURPOSE: c-erbB2 encodes 185 kDa oncoprotein with tyrosine kinase activity and has homology to the epidermal growth factor receptor. c-erbB2 proto-oncogene is found to be overexpressed in approximately 20 to 30% of primary breast cancer and has been associated with poor prognosis and lower response to conventional chemotherapy. MATERIALS AND METHODS: We perfonned a study on 40 infiltrating ductal breast cancers treated with primary surgery and adjuvant chemotherapy. We investigated c-erbB2 expression by immunohistochemistry in paraffin-embedded tissue using polyclonal antipeptide antibody(DAKO). We evaluated the relationships between its expression and the results after over 6 cycles of adjuvant chemotherapy including cyclophosphamide, methotrexate and 5-FU. RESULTS: The median age at diagnosis was 43 years and the median follow-up time was 47.3 months. Thirteen(32.1%) of 40 patients showed the c-erbB2 overexpression in the external domains of protein. There were no correlations among c-erbB2 amplification and other prognostic factors such as hormonal receptors, histologic grade and tumor size. Estrogen receptor and progesterone receptor showed tendency of inverse correlation with c-erbB2 overexpression but it was not statistically significant(p>0.05). c-erbB2 positive patients showed shorter disease free survival compared to c-erbB2 negative patients in univariate analysis(p0.05). CONCLUSION: These findings suggest that overexpression of c-erbB2 may be a marker of poor response to adjuvant chemotherapy with CMF regimen and may be an indicator of more aggressive therapy.